Expand nonmedical roles to give doctors training time, royal college says

Authors: Matthew Limb 

Publication date:  06 Jun 2016

Nonmedical staff should be given fully developed roles in extended surgical teams to let junior doctors devote more time to their training, the Royal College of Surgeons has said.

More patients could be treated by the growing numbers of nonmedical practitioners, such as advanced nurse practitioners, physician associates (PAs), and surgical first assistants, the college said.

This could enhance patient care, surgical training, and consultant teams—but the roles of nonmedical practitioners must be properly developed, “better aligned with the surgical profession,” and made part of the NHS’s workforce planning, it argued.

The college said that its report on the issue “challenged the status quo that doctors in training should be the default providers of frontline medical services.”

Ian Eardley, the College’s vice-president and a consultant urologist said, “If the NHS, government, and medical professionals don’t do more to properly plan how these roles are used and find ways to better support them in their careers, the opportunity to use them to their full potential could be missed.”

The report, entitled A Question of Balance: The Extended Surgical Team, was co-funded by Health Education England.[1]

It looked at how surgical training was seen by junior doctors, and the potential offered by the extended surgical team to improve training.

It found that there were concerns about the time available for core and foundation training, about the demands placed upon trainees to cover the service, and their exposure to common surgical conditions.

Some of the staff surveyed said that doctors in training today were less competent—and less useful to the service—than they used to be and that newly qualified consultant surgeons were often less confident.

The College said, “These perceptions, while anecdotal, confirm worries expressed by many within the surgical profession about the state of training.”

The report highlighted ways that well managed use of the extended surgical team could support doctors and enhance training.

These included letting doctors in training leave the wards to attend teaching, outpatient clinics, or theatres; aiding continuity of care; and helping new doctors settle into rotations more quickly.

It is also argued that extended surgical teams could be used to reduce the number of occasions that higher surgical trainees were called out of theatre, ease the administrative burden, and give consultants confidence to “step out of the room and leave senior trainees to operate with a skilled assistant.”

Eardley told BMJ Careers, “We found there were lots of ways a nonmedical workforce could support juniors—they could do some of the admin and some clinical tasks—and the impression we got was that it would enhance the training of the medics who were there.

“The view we came to was that often they provided the glue that held the medical team together.”

The College said that it found “no basis for concern” that the greater use of nonmedical practitioners—including in theatres—diluted surgical training opportunities for junior doctors.

But it said that there were challenges to making the most of the extended surgical team, including making roles clear—something that can be “confusing to patients.”

Standards should be developed to guide the evolution of new nonmedical roles within surgical specialties, the College said.

It said that Health Education England should consider if physician associates were being trained in sufficient numbers to support the surgical workforce.

In addition, there should be a close look at whether clinical placements were given enough exposure to surgery to attract physician associates into surgical departments once qualified.


  1. Royal College of Surgeons. A question of balance: The extended surgical team. [Link]

Matthew Limb
freelance journalist BMJ Careers


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